Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

Abstract

Objectives We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions LTC may be an important point of engagement in suicide prevention.

Suicide among nursing home residents in Australia: A national population‐based retrospective analysis of medico‐legal death investigation information

“…More males died from suicide than females and at a higher proportion (68.8%) than found in previous studies (~60%) . This is consistent with the high rate of suicide among older male adults in the general population, yet is surprising considering nursing home residents are predominantly females (70%) and exposed to the same environmental factors.…”

“…A full autopsy (including internal examination of the body) was conducted in 66% of cases (n = 93), and toxicological analysis was con- More males died from suicide than females and at a higher proportion (68.8%) than found in previous studies (~60%). 11,12,15,16,25 This is consistent with the high rate of suicide among older male adults in the general population, 1,23 yet is surprising considering nursing home residents are predominantly females (70%) and exposed to the same environmental factors. This research also found younger residents (<65 years) have higher odds of dying from suicide compared with older age groups.…”

“…This research also found most previous attempts occurred within 12 months (pre and post) date of admission to the nursing home. The 12‐month period immediately preceding and following admission to a nursing home is recognised as a particularly stressful transition period for older adults and may represent a high‐risk period for suicide. While the average length of stay in a nursing home is approximately 2 to 3 years, the first 12 months of residency represents a difficult time for new residents adjusting to a multitude of changes in their life .…”

“…10 Existing research is mostly from the US and limited to identifying individual risk factors (such as depression 11,12 ; physical health decline 11,13 ; admission to the nursing home in the last 12 months 11 ), and describing the most common methods of suicide; hanging 12,14,15 or fall from height. 14,15 Only 2 studies, conducted 25 years apart, have examined organisational factors associated with higher risk of suicide (including high staff turnover rate; <$100 per day bed cost; religious or fraternal ownership 13 ; better performance on quality indicators 16 ; and larger facility size). 13,16 Considering the institutional nature of nursing homes, there is a conspicuous lack of research examining organisational and systemic factors associated with suicide in this setting.…”

“…14,15 Only 2 studies, conducted 25 years apart, have examined organisational factors associated with higher risk of suicide (including high staff turnover rate; <$100 per day bed cost; religious or fraternal ownership 13 ; better performance on quality indicators 16 ; and larger facility size). 13,16 Considering the institutional nature of nursing homes, there is a conspicuous lack of research examining organisational and systemic factors associated with suicide in this setting.…”